School nurses save money: study

NEW YORK (Reuters Health) - A Massachusetts program that put
full-time registered nurses in schools more than paid for itself
by averting medical costs and lost work for parents and
teachers, according to a new study.

Many school districts have cut or reduced the hours of
school nurses in recent years, and nationwide less than half of
public schools have a full-time nurse, the authors of the report
note.

They say their results warrant "careful consideration" from
districts that are thinking of making such cuts in an effort to
save money.

"The findings of this study suggest that from a societal
perspective, the benefits of school nursing services may well
exceed the cost for those services," Li Yan Wang told Reuters
Health.

She led the research at the Centers for Disease Control and
Prevention's Division of Adolescent and School Health in
Atlanta, Georgia.

To assess the Massachusetts program, the researchers
compared money spent putting full-time nurses in schools with
money the program saved by reducing doctors' visits and keeping
parents at work and teachers in front of the classroom.

For the 22 types of procedures school nurses performed
during the study, from testing blood sugar to administering
physical therapy, the researchers calculated how much it would
cost to go to a clinic or hospital for the same care.

To measure lost wages for parents, they determined the time
parents would have to take off work if children were dismissed
early, as well as how often they would have to come to school to
help kids take their prescription medications if no nurse was on
site.

Finally, to assess teacher productivity, they referred to an
earlier study that found teachers spent 20 fewer minutes per day
dealing with student health issues once a nurse was assigned to
their school.

Massachusetts records showed that during the 2009-2010
school year, about 477,000 students at 933 schools covered by
the program received school health services. Paying nurses to
provide those services cost $79 million.

The same care provided outside of school would have cost $20
million. In addition, with no school nurses parent productivity
losses would have totaled $28.1 million and teacher productivity
losses, $129.1 million.

Wang and her colleagues calculated that every dollar
invested in the school nurse program saved $2.20 overall,
according to the findings published Monday in JAMA Pediatrics.

Anne Sheetz said those savings are just a start.

"We haven't looked at the number of emergency room visits
saved, we have not looked at the number of hospitalizations
saved . . . we have yet to look at the big savings," she told
Reuters Health. "This is just a drop in the bucket."

Sheetz, the study's senior author, retired last year as the
Director of School Health Services at the Massachusetts
Department of Public Health.

When she started the position, she said, "I could not
believe the amount of health care that was being done in schools
and the critical nature of it."

School nurses, Sheetz said, see 60 to 70 kids each day. They
have to be ready to provide emergency care and mental health
services and help manage chronic conditions like diabetes.
Nurses are also charged with teaching other members of the
school community about issues such as life-threatening food
allergies.

"The role of the school nurse has really expanded," said
Martha Keehner Engelke, who has studied that topic at East
Carolina University in Greenville, North Carolina but wasn't
involved in the new report.

"People think of it as doing vision screening and putting on
Band-Aids," Engelke told Reuters Health. "Those things are
there, but that's a really small part of what school nurses do."

Two local doctors who have worked with the Massachusetts
school health services program, pediatric allergist Dr. Michael
Pistiner of Harvard Vanguard Medical Associates and
endocrinologist Dr. Maryanne Quinn of Boston Children's
Hospital, agreed that it has had a considerable impact on kids'
health in both of their specialties.

"Cost has been a very real barrier," Pistiner said.

The new study, he added, "may change these conversations. It
may put getting a full-time school nurse back on the priority
list."

SOURCE: http://bit.ly/1adWrco JAMA Pediatrics, online May
19, 2014.

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